Program Operations Manual System (POMS)

DI 11080.001 Consolidated Omnibus Budget Reconciliation Act (COBRA)

On April 7, 1986, Congress enacted the Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions. COBRA provides continuation of group health insurance coverage to certain workers and their families that would otherwise be terminated. These COBRA provisions generally apply only to employers with 20 or more employees.

Several agencies administer COBRA continuation provisions. The Departments of Labor and Treasury have jurisdiction over private-sector group health plans. The Department of Health and Human Services administers the continuation coverage law as it affects public-sector health plans.

IMPORTANT: In 1989, Congress amended COBRA to allow qualified individuals who stopped working due to disability to extend their health insurance coverage.

The Social Security Administration (SSA)is only responsible for making disability decisions for the extension of COBRA coverage under the provisions described in DI 11080.001C in this section.

An employee, the employee’s spouse, and the employee’s dependent children covered by a group health plan on the day before a “qualifying event” are qualified individuals. In certain cases, a retired employee, the retired employee’s spouse, and the retired employee’s dependent children may be qualified beneficiaries. In addition, any child born to, or placed for adoption with a covered employee during the period of COBRA coverage is a qualified individual.

A qualified individual entitled to an 18-month maximum period of coverage continuation, may become eligible for an extension when a qualified beneficiary (employee, spouse, or child) is disabled. To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must:

Have a determination from the Social Security Administration that he or she became disabled prior to the expiration of the 60th day of COBRA continuation coverage.

Send the plan administrator a copy of the Social Security determination letter within 60 days of receipt, but prior to expiration of the 18-month period of coverage.

If the qualified individual meets these requirements, the entire family qualifies for an additional 11 months of COBRA continuation coverage (for a total maximum period of 29 months).

The individual must also notify the plan administrator within 30 days of any determination that he or she is no longer disabled.

Under the law, the premium for this coverage will not exceed 150 percent of the group rate for the additional 11 months of coverage.

Contact DOL for any routine questions concerning the COBRA provisions.